Objectives To evaluate the reporting trends and clinical impact of the CAD-RADS modifier high-risk plaque (HRP). Materials and methods Radiology reports of cardiac CT angiography performed in a tertiary referral hospital between October 2017 and December 2021 were retrospectively reviewed. Cases coded with modifier HRP or with CT reports mentioning HRP were defined as “HRP-reported.” The prevalence of HRP-reported cases was analyzed. Subsequent management within 90 days post-CT was reviewed for cases with suspected stable angina. Results Among the 21503 cases (mean age, 62.7 years ± 12.3 [SD]; 11,127 men) enrolled, 169 cases (0.8%) were HRP-reported. HRP-reported cases were more frequent in cases with suspected acute coronary syndrome or stable angina than others (1.2% vs. 1.1% vs. 0.1%; p < 0.001), protocols for coronary CT angiography or triple-rule-out CT, compared to others (1.1% vs. 0.7% vs. 0.1%; p < 0.001), and cases with higher coronary artery calcium or CAD-RADS categories (p for trends < 0.001). HRP reporting rates varied among the readers, ranging from 0.1 to 1.3%. In the setting of suspected stable angina, the HRP-reported group more frequently underwent invasive coronary angiography in CAD-RADS 1–2 (8.8% vs. 1.4%; p = 0.01), stress testing in CAD-RADS 3 (38.5% vs. 18.4%; p = 0.02), and coronary revascularization in CAD-RADS 3 (23.1% vs. 8.7%; p = 0.02) or 4–5 (75.0% vs. 54.6%; p = 0.001). Conclusion The CAD-RADS modifier HRP impacted the management of patients with CAD. However, its reporting prevalence was low and varied depending on the readers and clinical settings. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> Data on the real-world clinical use of CAD-RADS high-risk plaque features on cardiac CT angiography are limited. <Emphasis Type="BoldItalic">Findings</Emphasis> The reporting prevalence of high-risk plaque was low and varied among radiologists and clinical settings in a large academic hospital. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> This study reveals the underreporting and variability in reporting practices of high-risk plaque on cardiac CT angiography, despite its importance in managing patients with coronary artery disease. Graphical Abstract

Reporting trends and clinical impact of high-risk coronary plaques on cardiac CT angiography in CAD-RADS

期刊论文
发表日期：

2025年7月30日

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Won-Seok Yoo,
Young Joo Suh,
Suji Lee,
Jin Hur,
Young Jin Kim

摘要

Objectives

To evaluate the reporting trends and clinical impact of the CAD-RADS modifier high-risk plaque (HRP).

Materials and methods

Radiology reports of cardiac CT angiography performed in a tertiary referral hospital between October 2017 and December 2021 were retrospectively reviewed. Cases coded with modifier HRP or with CT reports mentioning HRP were defined as “HRP-reported.” The prevalence of HRP-reported cases was analyzed. Subsequent management within 90 days post-CT was reviewed for cases with suspected stable angina.

Results

Among the 21503 cases (mean age, 62.7 years ± 12.3 [SD]; 11,127 men) enrolled, 169 cases (0.8%) were HRP-reported. HRP-reported cases were more frequent in cases with suspected acute coronary syndrome or stable angina than others (1.2% vs. 1.1% vs. 0.1%; p < 0.001), protocols for coronary CT angiography or triple-rule-out CT, compared to others (1.1% vs. 0.7% vs. 0.1%; p < 0.001), and cases with higher coronary artery calcium or CAD-RADS categories (p for trends < 0.001). HRP reporting rates varied among the readers, ranging from 0.1 to 1.3%. In the setting of suspected stable angina, the HRP-reported group more frequently underwent invasive coronary angiography in CAD-RADS 1–2 (8.8% vs. 1.4%; p = 0.01), stress testing in CAD-RADS 3 (38.5% vs. 18.4%; p = 0.02), and coronary revascularization in CAD-RADS 3 (23.1% vs. 8.7%; p = 0.02) or 4–5 (75.0% vs. 54.6%; p = 0.001).

Conclusion

The CAD-RADS modifier HRP impacted the management of patients with CAD. However, its reporting prevalence was low and varied depending on the readers and clinical settings.

Key Points

Question Data on the real-world clinical use of CAD-RADS high-risk plaque features on cardiac CT angiography are limited.

Findings The reporting prevalence of high-risk plaque was low and varied among radiologists and clinical settings in a large academic hospital.

Clinical relevance This study reveals the underreporting and variability in reporting practices of high-risk plaque on cardiac CT angiography, despite its importance in managing patients with coronary artery disease.

Graphical Abstract